Research Article Clinical Significance of Renal Allograft Protocol Biopsies: A Single Tertiary Center Experience in Malaysia Mei Sian Fu, 1 Soo Jin Lim, 2 Maisarah Jalalonmuhali , 2 Kee Seong Ng, 3 Soo Kun Lim, 2 and Kok Peng Ng 2 1 Department of Medicine, Hospital Segamat, 85000 Segamat, Johor, Malaysia 2 Division of Nephrology, Department of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia 3 Department of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia Correspondence should be addressed to Maisarah Jalalonmuhali; mai jalal@yahoo.com Received 3 November 2018; Revised 15 February 2019; Accepted 17 March 2019; Published 2 May 2019 Academic Editor: Gian Luigi Adani Copyright © 2019 Mei Sian Fu et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Te role of protocol renal allograf biopsy in kidney transplantation is controversial due to the concern with procedural-related complications; however, its role is slowly evolving. Recent evidence suggests that protocol biopsy is useful in detecting subclinical renal pathology. Early recognition and treatment of renal pathologies can improve long-term outcomes of renal allografs. Methodology. A total of 362 renal allograf protocol biopsies were performed in adult recipients of kidney transplantation between 2012 and 2017. Afer excluding those with poor quality or those performed with a baseline serum creatinine level >200umol/L, we analyzed 334 (92.3%) biopsies. Histology reports were reviewed and categorized into histoimmunological and nonimmunological changes. Te immunological changes were subcategorized into the following: (1) no acute rejection (NR), (2) borderline changes (BC), and (3) subclinical rejection (SCR). Nonimmunological changes were subcategorized into the following: (1) chronicity including interstitial fbrosis/tubular atrophy (IFTA), chronic T-cell-mediated rejection (TCMR), unspecifed chronic lesions, and arterionephrosclerosis, (2) de novo glomerulopathy/recurrence of primary disease (RP), and (3) other clinically unsuspected lesions (acute pyelonephritis, calcineurin inhibitors toxicity, postinfective glomerulonephritis, and BK virus nephropathy). Risk factors associated with SCR were assessed. Results. For the histoimmunological changes, 161 (48.2%) showed NR, 145 (43.4%) were BC, and 28 (8.4%) were SCR. Tese clinical events were more pronounced for the frst 5 years; our data showed BC accounted for 59 (36.4%), 64 (54.2%), and 22 (40.7%) biopsies within <1 year, 1-5 years, and > 5 years, respectively (p = 0.011). Meanwhile, the incidence for SCR was 6 (3.7%) biopsies in <1 year, 18 (15.3%) in 1-5 years, and 4 (7.4%) in >5 years afer transplantation (p=0.003). For the nonimmunological changes, chronicity, de novo glomerulopathy/RP, and other clinically unsuspected lesions were seen in 40 (12%), 10 (3%), and 12 (3.6%) biopsies, respectively. Living-related donor recipients were associated with decreased SCR (p=0.007). Conclusions. Despite having a stable renal function, our transplant recipients had a signifcant number of subclinical rejection on renal allograf biopsies. 1. Introduction Renal biopsy is the gold standard in determining the cause of renal allograf dysfunction. Renal allograf protocol biopsy is defned as biopsy performed at predefned intervals afer transplantation, which is unrelated to graf dysfunction. Traditionally, the indications of renal allograf biopsy were either due to the changes in the patient’s clinical condition or abnormal renal biochemical parameters. For the past few decades, there has been a paradigm shif in the indications of renal allograf biopsies. Several studies suggested that early acute rejection episodes and chronic changes in the allograf kidneys were ofen subclinical with- out a concomitant rise in serum creatinine or proteinuria [1–4]. Hence, performing a preemptive renal allograf biopsy may help with identifcation of acute or chronic rejection as it may potentially alter the outcome of renal allograf that is amenable to treatment. Due to the above fndings, some centers have started to implement protocol biopsy program. Acceptance of protocol biopsy is gaining momentum worldwide in view of recent studies which suggest that protocol biopsy is useful in Hindawi Journal of Transplantation Volume 2019, Article ID 9153875, 8 pages https://doi.org/10.1155/2019/9153875